The goal of this research plan is to examine how pregnancy-related sleep disturbances may increase the incidence of pregnancy complications. There is a growing interest in the role of inflammation in the pathogenesis of pregnancy complications, and it is possible that sleep may play an important role in the relationship between inflammatory processes and pregnancy complications. Women often endorse disruption of sleep during pregnancy with frequent complaints of poor sleep quality, increased nocturnal awakenings and long periods of wakefulness. There is a mounting literature demonstrating an association between disturbed sleep (poor quality, poor continuity or short sleep duration) and increases in circulating and secreted levels of proinflammatory cytokines in nonpregnant populations. Preliminary work conducted during my graduate career provides initial evidence that pregnancy-related sleep disturbances are associated with similar alterations in proinflammatory cytokines. These same proinflammatory cytokines, shown to be altered with sleep disruption, are similarly associated with pregnancy complications such as spontaneous abortion, preeclampsia, gestational diabetes, and preterm labor and birth. Aim 1. Examine the role of sleep in pregnancy complications. Hypothesis 1: Disturbed sleep will be associated with increased incidence of pregnancy complications including spontaneous abortion, preeclampsia, gestational diabetes, and preterm labor and birth. Aim 2. Examine the temporal relationship between sleep and proinflammatory cytokines during pregnancy. Hypothesis 2: Disturbed sleep will be associated with subsequent increases in proinflammatory cytokines.Aim 3. Examine the role of sleep related increases in proinflammatory cytokines in pregnancy complications. Hypothesis 3: Sleep related increases in proinflammatory cytokines will be associated with increased incidence of pregnancy complications including spontaneous abortion, preeclampsia, gestational diabetes, and preterm labor and birth. A total of 120 pregnant women will be studied across pregnancy. Each woman will participate in a 15-day assessment once per trimester. These assessments will include sleep data attained by actigraphy, sleep diary and sleep questionnaires; cytokine data ascertained from plasma and stimulation assays; health behaviors assessed by self-report; and data on pregnancy complications provided by medical records. [unreadable] [unreadable] [unreadable]